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ACE-RT, A Cloud-Based Tool for Remote Radiotherapy Contouring Support in Lower-Resourced Settings: A Pilot

T Hope-Johnson1, G B Prajogi2, E Addison3

  • 1Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom; Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|November 26, 2025
PubMed
Summary
This summary is machine-generated.

A new cloud-based tool, ACE-RT, enhances radiotherapy contouring training in low-resource settings by facilitating remote feedback and skill development. Despite challenges with internet connectivity, the software proved feasible and acceptable for improving radiotherapy education.

Keywords:
Cloud-based softwareco-designcontouringradiotherapy training

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Area of Science:

  • Medical Physics
  • Radiation Oncology Education
  • Digital Health

Background:

  • Radiotherapy training in low- and middle-income countries (LMICs) is limited by clinician shortages and high workloads.
  • Previous remote review software for radiotherapy planning faced implementation challenges in LMICs due to poor IT infrastructure and connectivity.
  • There is a need for accessible digital learning tools to improve radiotherapy contouring skills in resource-limited settings.

Purpose of the Study:

  • To develop and evaluate a novel cloud-based software, ACE-RT, designed to support radiotherapy planning and training in lower-resourced settings.
  • To assess the feasibility, acceptability, and appropriateness of ACE-RT for improving radiotherapy contouring skills.
  • To identify implementation barriers and facilitators for using digital learning tools in LMICs.

Main Methods:

  • Co-design of the cloud-based ACE-RT software with radiotherapy professionals from Ghana, Zambia, and the UK, focusing on LMIC needs (bandwidth, UI, functionality).
  • Evaluation of ACE-RT by a radiation oncology consultant and trainee in Indonesia over six months.
  • Assessment of remote feedback provision, skill development portfolio function, and user experience.

Main Results:

  • The ACE-RT software facilitated successful remote feedback on radiotherapy plans.
  • Both consultants and trainees reported improved quality and quantity of feedback, and easier provision/receipt of tailored feedback.
  • Users found the portfolio function valuable for tracking skill development; poor internet connectivity and file export complexity were key implementation barriers.

Conclusions:

  • The cloud-based ACE-RT tool is a feasible, acceptable, and appropriate solution for enhancing radiotherapy contouring training in resource-limited settings.
  • Unstable internet connectivity remains a significant barrier to the widespread implementation of such digital tools.
  • Further development is recommended to optimize ACE-RT for variable internet speeds, with broader evaluation across diverse centers.